=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821379389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAP PAN CHU PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2011
-----------------------------------------------------
Last Update Date | 05/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25684 DIXIE HWY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-8878
-----------------------------------------------------
Fax | 419-874-8898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25684 DIXIE HWY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-8878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302035032
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03127308
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------